Question 5: Who should evaluate the infertile couple?

I was never sure if I had all my shots as a child. With a father who was a general surgeon all of my camp forms were filled out at home. My Dad would pretty much just make up dates that seemed reasonable. I bet that many of these forms had me getting shots on major holidays and weekends but no one ever seemed to care.

When my Mother was 40 years old she stopped getting her period and felt pretty awful....tired, sick, nauseated etc. She asked my Dad what his diagnosis was and he replied "menopause." He snorted when she suggested that she might me pregnant. I arrived 7 months later! So my suggestion is to avoid getting fertility advice from general surgeons. Ob/Gyns are another story and in many cases the fertility evaluation can be initiated without a specialist. However, for patients over 35 yrs old and those with prolonged infertility or a recognized issue, it may make more sense to start with an RE.

So here is part 1 of the weekend edition of 100 Q&A about Infertility:

5. Who should evaluate the infertile couple? Do I need to see a Reproductive Endocrinologist?


In many cases, the routine fertility evaluation can be conducted by an obstetrician/gynecologist, or a family practitioner. Certain tests can easily be ordered and interpreted by physicians in the first two specialties, but a reproductive endocrinologist (RE) may be required to interpret advanced testing and provide the most accurate counseling. Women who are more than 34 years old may elect to immediately consult with a reproductive endocrinologist.

Although all physicians trained in obstetrics and gynecology are exposed to the specialty of reproductive endocrinology and infertility, this training may by cursory at best. On the other hand, a reproductive endocrinologist (RE) is a physician who specializes in the treatment of reproductive disorders and infertility. A physician specializing in reproductive endocrinology undergoes 4 years of training in general obstetrics and gynecology following his or her completion of medical school. At the end of these 4 years internship and residency (which includes exposure to normal and high-risk obstetrics, gynecology, gynecologic oncology, and reproductive endocrinology and infertility) a physician may then apply for an additional 3-year fellowship in reproductive endocrinology and infertility. There are usually only 25-35 fellowship positions available each year so competition can be intense. After completing these 7 years of training, the physician takes a series of written and oral examinations to become board certified in this specialty. Although not all practitioners of reproductive endocrinology and infertility have undergone formal fellowship-level training, the majority have, and this training includes both clinical and basic science experience.

There are several professional organizations for physicians who are interested in the treatment of the infertile couple, including the American Society of Reproductive Medicine (ASRM) and the Society for Reproductive Endocrinology and Infertility (SREI). Any physician who is interested in infertility may join ASRM, but members of SREI must be board eligible or board certified in reproductive endocrinology and infertility. Both of these organizations maintain websites that allow patients to identify local specialists (www.asrm.org; www.socrei.org).


Carol comments:

I began discussions with my gynecologist at age 34 regarding my lack of success at getting pregnant. He put me on a plan that seemed to represent a pretty standard process of elimination. First, I did the basal body temperature charting for 3 months to determine if I was ovulating; then, I spent 3 months on Clomid with no success. Looking back on it now, I question his resistance to send me directly to an RE for further evaluation given my age and what the ovulation charting had revealed. Don’t be afraid to push your doctors. I wish I would have pushed harder to get things moving.